Swaziland has the highest prevalence of human immunodeficiency virus (HIV) in the world. Attrition (loss to follow-up and mortality) in people living with HIV/AIDS (PLWHA) already on treatment is a major challenge, undermining achievements of the antiretroviral treatment (ART) programme in Swaziland. The contributing factors to attrition in the Swazi context are unclear. This study aims to (1) estimate attrition from the ART programme 12 months after ART initiation in Swaziland, and (2) determine the predictors of attrition in PLWHA treated with ART in Swaziland. A retrospective cohort study using national baseline data was conducted. A competing-risk Cox proportional hazard regression was used to determine the predictors of attrition. We estimated 10·3% (95% confidence interval 10·1-10·6) attrition in 16 423 participants that initiated ART in 2012. Attrition was significantly associated with sex, age, district, treatment supporter at initiation, co-infection of HIV and TB, functional status, WHO clinical stage, and ownership of facility. Our study can form a base of policies, plans, and service delivery strategies for preventing and controlling attrition in Swaziland.
BackgroundPackaging medications is a crucial component of health system efficiency and quality. In developing countries, medications often arrive in bulk containers that need to be counted by hand. Traditional counting is time-consuming, inaccurate and tedious. SAFEcount is a novel and inexpensive handheld device that may improve the accuracy and speed of pill-counting in resource limited settings. We designed a head-to-head trial to compare traditional and SAFEcount prescription filling in eSwatini.MethodsWe recruited 31 participants from 13 health facilities throughout eSwatini. Speed and accuracy for each prescription was recorded while each participant filled prescriptions of various quantities using both the traditional and SAFEcount methods.ResultsTraditional pill counting resulted in an error rate of 12.6% inaccurate prescriptions compared to 4.8% for SAFEcount (p<0.0001). SAFEcount was 42.3% faster than traditional counting (99.9 pills per minute versus 70.2; p<0.0001). Using SAFEcount was preferred over traditional pill counting by 97% (29/30) of participants.ConclusionsThe SAFEcount device is a preferred alternative by counting personnel and is significantly faster and more accurate compared to traditional counting methods. SAFEcount could help improve the efficiency and quality of health care delivery in place of traditional hand counting.
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